Covid is hitting the UK hard and many are questioning the efficacy of a nationwide lockdown.
The current lockdown has been imposed by the UK government based on one document from Imperial College Covid-19 Response Team supported by Centre funding from the UK Medical Research Council under a concordat with the UK Department for International Development, the NIHR Health Protection Research Unit in Modelling Methodology and the Abdul Latif Jameel Foundation. This document of 20 pages, peer reviewed by Neil M Ferguson, et al.; and was published on 16th March 2020 is mostly based on assumptions from historic epidemics. Many of the graphs, tables and information has now been proven to be inaccurate, yet this is still the imperative the UK government is adhering to. Ferguson implicates that quarantine is needed until a vaccine becomes available (potentially 18 months) and has stated that schools will double the infection rate. He also predicted 500,000 deaths and his track record from predicting historic health crisis’ have been somewhat inaccurate.
As of 1st May 2020, we now have empirical data to base true statistical and mathematical models, antithetical to assumptions.
What has really upset me personally whilst writing this paper, is discovering such a huge amount of confusing and conflicting information, at the same time realising certain people / businesses pushing their own agenda, whilst not being in favour of people’s health. And a huge campaign has been followed by the media (and others) to insight fear and pull on your most vulnerable heart strings and for me this is truly soul destroying. For all the fake news and false information sent on WhatsApp groups, news channels and video streams, I believe these people should be highlighted and removed from any inclusion in providing any valuable information in future pandemics.
We need hard facts on treatments being trialled across the globe such as UV and blood plasme and a real look into hospitals, with a “realistic” filter, and not a “fear” filter. Decisions to build huge Covid hospitals and paying people for not working is not really helping people in the long run if they have to pay the loans back, with interest.
In this paper I set out to show the best route forward to successfully curve the excess Covid mortality rate whilst minimising the social and economic impact of Covid.
Actual number of Covid deaths
Firstly we need to look at the actual death rates, total cases and patients in ICU taking into consideration errors or variances in reporting (in the UK);
As of 1st May 2020, there have been 27,510 hospital deaths reported by Worldometers.info, a popular source of information to measure (Covid) statistics used by the UK Government, the FT and the New York Times. Worldometers’ team manually and autonomously measure thousands of publications daily to provide statistical datasets.
The Office of National Statistics (ONS) has been holding and recording daily death rate data and other statistics across the UK (and globally) since 1993. During the previous 5-year timeframe from 2015 to 2020, on average 10,497 people died every week in the UK, this meanfigure is used most publications. Table 2 illustrates the weekly death rate not specifically related to Covid in the UK since the beginning of 2020;
Table 2; 2020 weekly death rates in the UK
(Table 2 enlarged)
In January 2020 the UK averaged 12,790 weekly deaths. You can see an increase in deaths in January 2020 then a decrease across February, March and an increase in April if you compare this to the average weekly deaths of 10,497. The proportionate death rate in 2019 is not too dissimilar with the UK average weekly death rate (calculated by averaging the 4 weekly ONS results) totaling 11,791.
Table 3; 2019 weekly death rates in the UK
(Table 3 enlarged)
To summarise, the average weekly death rate in January 2019 in the UK was 11,791. The weekly death rate in January 2020 in the UK was 12,790 an increase of 1,000 deaths per week. Although there are many reasons for varying death rate, at this stage it would be hard to apportion these deaths to Covid without statistical evidence from February, March and April 2020 because there have been weeks in history with a higher death rate than 12,790.
However, April 2020 is where we clearly see an increase in weekly death rates across the UK. If Covid incubation period is 1-2 weeks and community spread across the population has been steady, we would expect to see these numbers increase and then peak; a path they now seem to be following. My friend works in the ICU at Imperial and informed me that numbers have drastically decreased with patients in ICU, therefore the NHS currently is not overwhelmed and hospital beds are readily available. This does not match the current modelling carried out by Imperial College, figure 5 stating we are still at the beginning of the upward curve.
The Imperial paper headed by Ferguson modelled at its peak 10,780 deaths per day in the UK in late May with a total of 510,000 deaths in the UK, which would mean a continued isolation well into August to curb death rates. This image below is from Ferguson's paper and looks to be inaccurate by a factor of more than 10x;
You can see from the chart above that Ferguson’s figures are grossly over estimated and lockdown into August would not be beneficial for the UK. We have now hit the peak with the daily death rates slightly reducing, to 795 daily reported deaths as of 1st May. I expect this number to steadily fall from here.
There are many assertions that Covid death rates are not being calculated properly and I will touch on that in this document. However, the ONS published data for weekly death rates for week ending 17thApril 2020 totalling 22,351 which is 12,041 more deaths in the week ending 7thApril compared to the average weekly death rate in the month of April in 2019 (of 10,310 deaths).
The 12,041 additional weekly UK deaths, taking into account all anomalies, is clearly an additional number of UK deaths and should be broadly ascribed to Covid. The primary characteristic of this weekly UK death toll is that these deaths have occurred from a cumulative increase in Covid cases since December 2019, leading to death but spread over a period of illness of 2-5 weeks prior to the reported death date. Therefore we should see next weeks results for death rates for w/e 24thApril peak even higher with the inclusion of care home related Covid deaths and from May this delta change as a percentage should start to decrease.
Based on these figures we expect the death numbers from Covid to be less than 40,000 in this wave.
Age of death
In the UK, as of the week ending 17th April a total of 19,088 people have reportedly died of Covid (source; ONS). Of these 19,088 people, in the 0-44 age range a total of 229 people have died including men, women and children (table 5).
There have been no confirmed cases of transmission from child to adult. Children are not immune to Covid but their symptoms are far milder, therefore we need to refrain children from seeing their grandparents, or parents over 44. However, only a handful of child deaths have been reported, the consequences due to school closures and lowered natural immunity and other social impacts are more severe paradoxically than the current lockdown measures.
Now if we take the highest effected age group of 40-44 year olds, totalling 49 deaths in every 19,088 deaths and compare this to the most highly effected age group 85-89, we can see that the 85-89 year old age group are 35x more susceptible to death than 40-44 year olds. However, there are 4x as many 40-44 year olds in the country than there are 85-89 year olds (https://www.statista.com/statistics/281174/uk-population-by-age/) so we can calculate that if you are 40-44 you are 140x less likely to die from Covid, once infected than if you are 85-89. We can therefore assume that Covid impacts the elderly far more veraciously than the younger and middle-aged population.
Naturally, the older we get the more comorbidities we have and this is also part of the reason our older generation are becoming susceptible to this virus.
The British Medical Journal published a paper to show that 78% of people are asymptomatic, although this data was largely from you China. A second paper published by the BMJ on 23rd March 2020 showed that 50-75% of people infected with Covid in Italy were asymptomatic;
“In an open letter to the authorities in the Tuscany region,1 Romagnani wrote that the great majority of people infected with Covid-19—50-75%—were asymptomatic, but represented a formidable source” of contagion.”
229 people have died below the age of 45 out of 19,088 UK deaths. If we assume a 75% asymptomatic rate (Source; The British Medical Journal) out of 177,454 positive Covid cases, the UK would have a total of 709,816 positive cases.
Table 5; UK weekly Covid death rates by age
Biological age- An extremely healthy 60 year old could have a biological age of 50. So if you are in your late 40's but very healthy you could assume to be in this category, much like if you are 35 and extremely unhealthy.
To summarise; 229 people under 45 have died out of 19,088 total deaths, 177,454 confirmed positive cases out of a total of 709,816 estimated cases which would be a 0.03% death rate in the Covid population and 0.13% in the symptomatic Covid population.
Pre-existing condition (comorbidities)
“A pre-existing condition is defined as any condition that either preceded the disease of interest (for example, COVID-19) in the sequence of events leading to death, or was a contributory factor in the death but was not part of the causal sequence.”
In March 2020 around 89% of death certificates listed “Covid-19” as a reason for death. We can safely say that not all of these 89% of deaths were directly caused by Covid based on areas I have already covered.
The majority of people dying from Covid have serious underlying conditions. In men and women under 70 years old;
- 10.6% of females had no pre-existing conditions, and
- 11.7% of males had no pre-existing conditions
Source; ONS, Table 7
Table 6; Covid weekly death rates by age
Table 7; % of Covid-related deaths with pre-existing conditions
Therefore out of the 229 deaths in people aged between 0 and 44, we can roughly speculate that far more than 90% had pre-existing health conditions. Because naturally you would expect more people aged between 45 and 69 to have comorbidities, think children for example.
To summarise; The population in the UK is 66.65m, if we assume a 0.03 death rate in the 0-44 age range. Half the population (Source; Wikipedia) of 36.7m people are under 45 years old. If we keep people with pre-existing conditions in isolation, but end isolation for everyone else under 45 we would expect to see a maximum death rate if 100% of the population were infected with Covid to be 1,101.
Why do we have a 50% death rate when a patient is admitted to ICU
Covid patients are admitted to ICU when they have trouble breathing. It is worthy to note that there are 4 types of ventilation from CPAP to less intrusive upper and lower respiratory ventilation.
If you are admitted into ICU under any circumstance, your condition must be categorised as severe and pass a number of positive control checks, in other words, you would already be in very poor and declining health to enter ICU. Although I have read death rates in ICU prior to Covid was 10%, the actual death rate in ICU patients receiving ventilator support for Acute Respiratory Distress Syndrome (ARDS) problems, before Covid was 52% reported in a 28 day National study back in 2002; https://jamanetwork.com/journals/jama/fullarticle/194560
“Results Of the 15,757 patients admitted, a total of 5183 (33%) received mechanical ventilation for a mean (SD) duration of 5.9 (7.2) days. The mean (SD) length of stay in the intensive care unit was 11.2 (13.7) days. Overall mortality rate in the intensive care unit was 30.7% (1590 patients) for the entire population, 52% (120) in patients who received ventilation because of acute respiratory distress syndrome, and 22% (115) in patients who received ventilation for an exacerbation of chronic obstructive pulmonary disease.”
We could further determine alternative reasons for a seemingly high death rate, all with good possibility although difficult to define exact numbers. To look at alternative reasons for causation of death;
- Viral load. When Covid patients enter a hospital with high numbers of other Covid patients and infected hospital staff, viral load would increase, worsening the symptoms and effects.
- Human error. Some patients may not need ventilator support, even if they have trouble breathing. Giving full CPAP would damage someone’s lungs and will have caused unnecessary deaths.
- Ibuprofen, although not proven, has been reported to worsen symptoms (Michael Yo).
Conclusion and recommendation
If we were to view Covid in equal measure to the common influenza virus (the flu) but without therapeutics (medicine such as antibiotics) or a vaccine (such as the flu jab), then hospitals would be seeing patients today in equal measure for the flu. However we do expect antibody immunity to last one or two seasons. We are uncertain how preventive a vaccine would be as there would be multiple strains of the corona virus.
There have been no confirmed cases of child to adult transmission (contrary to N. Fergusons paper), therefore schools should return to normal immediately.
229 people have died below the age of 45 out of 19,088 UK deaths and 177,454 confirmed cases. Assuming a 75% asymptomatic rate (Source; The British Medical Journal) would total 709,816 cases and a 0.03% death rate in under 45’s.
At worst case at least 90% at least of UK death rates can be attributed to pre-existing health conditions bringing the healthy 0 to 45 year old death rate to 0.003%. If 100% of the UK were infected with Covid we would see a maximum new death rate in this age range of 1,101 people. Firstly, there would not be a 100% infection rate and secondly, many more than 1.101 people could die in the 0-44 age range as an indirect consequence of the lockdown if it was extended into August (depression, domestic abuse, suicide, unrest etc.).
Either 1,101 people die now, or die over a 3 year period, slowing the process for everyone. There is an argument to say over the next 18 months therapeutics and vaccines will play a part in saving people’s lives but do we want to wait 18 months to avoid the inevitable if this is no more dangerous than the common flu to the majority of the working population. I feel there will be more than 1,101 deaths due to the indirect consequence of isolation, just think of all the elderly now living alone who have been told not to leave their homes, who rely on food delivery slots which are now full for months ahead.
Therefore I recommend allowing anyone below the age of 45 with NO pre-existing conditions back to work immediately. I propose;
- All schools to go back with immediate effect
- Children to not stick to existing rules and not see grandparents
- Everyone below 45 with no comorbidities goes back to work with immediate effect
- Stay at home if you have severe asthma or one of these pre-existing conditions; https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/methodologies/userguidetomortalitystatistics/leadingcausesofdeathinenglandandwalesrevised2016
- Stay home if you received a letter from the NHS that you are in the higher risk category
- 45 - 65 year olds stay at home from 7th May for 2 weeks
- 45 – 65 year old key health workers can go to work, but must not travel on public transport
- 45 – 65 year old teachers must stay at home (no PPE)
- 65+ stay at home from 7th May for 4 weeks
- Anyone who tests +ve goes home and self-isolates, anyone who has been with them who shows symptoms, isolates for 7 days or until symptoms go away
- Test all staff weekly. Not only key workers, but all hospital staff.
- Open cancer treatment surgeries and hospital areas with immediate effect.
- From the money that I will be saving the Furlough scheme, give every worker putting themselves at risk (medical, scientific and food supply chain) a 3 months bonus payment
- Do NOT cough or sneeze over anyone, walk out the room if you have to sneeze
- For the first two weeks keep a safe distance from people
- Do NOT order more than 2 weeks of food at once, doing this is harming others
- Help your neighbours, if you know anyone stuck indoors maybe put them on a group WhatsApp chat and offer to pick them up some groceries, or FaceTime them
This does unfortunately mean more people will get sick so we recommend everyone coming out of isolation follow this protocol;
- Early nights to keep up immunity
- Exercise at least every other day
- Get at least one hour of natural sunlight per day when the sun is out
- Intake healthy amounts of vitamin C from natural food sources
- We encourage intermittent fasting
- We encourage the Wim Hoff breathing exercise
- If you can afford it; Spirulina, Zinc and Vitamin C
- Equally if you can afford it, have your bloodwork taken; CBP, mineral & vitamin levels (including Vitamin D)
- Less alcohol consumption, not excessive
I have ran 3 different calculations using different metrics to see if I am under estimating the number of deaths, and each time the number comes to approximately 1,000 deaths +/- 100%.
For example, we can safely conclude that approximately 90% of all Covid cases in patients under the age of 70 have one or more pre-existing conditions. There’s no reliable data on the under 45 age range, however if 15x more people are killed by Covid in the under 70’s age range compared to the under 45 age range (and there are more people under 45 than between 45 and 70), we can roughly speculate that in the under 45’s the % of patients who die of Covid with NO pre-existing conditions would be < 1%. However I would be happy to run modelling at 5% for safety precautions and numbers still total 1,000 +/- 100%.
It appears Boris was broadly speaking correct in his initial assumptions. It is fortunate people have been in quarantine not to overwhelm the NHS in the aged population. We need to continue to run data models over the coming weeks to calculate when would be best to bring age groups 45-65 and 65+ out of lockdown.
Modelling chart- show UK numbers other next 3 months with and without isolation - show temperature increase should help- Hospitals are not overloaded- We drove to the major hospitals in the UK